Healthcare Provider Details

I. General information

NPI: 1588916282
Provider Name (Legal Business Name): CROWN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 1ST AVE S
MINNEAPOLIS MN
55403-3724
US

IV. Provider business mailing address

1925 1ST AVE S
MINNEAPOLIS MN
55403-3724
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-4354
  • Fax: 612-872-4343
Mailing address:
  • Phone: 612-871-4354
  • Fax: 612-872-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number209405-6
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOYCE IHIOMA ONYEKABA
Title or Position: DIRECTOR
Credential: M.D
Phone: 612-978-3783